5 Ethics - global health Flashcards
Why should we care about global health ethics?
- It benefits us
- Humanitarian duty of assistance (Peter Singer)
- Justice:
• No moral significance to country boundaries
• Legacy and reparation
• Human rights and global responsibility to their realisation
What is the WHO constitution of health and human rights in 2006?
The enjoyment of the highest attainable standard of health issue is one of the fundamental rights of every human being without distinction of race, religion, pollination belief, economic or social condition
What is the Universal Declaration of Human rights (UN) (1948)?
• Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control
• Motherhood and childhood
are entitled to special care and assistance
• All children, whether born in or out of wedlock, shall enjoy the same social protection
What is the International Covenant on economic, Social and Cultural Rights (1976)?
The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
What is the UN Convention on the Rights of the Child (1990)?
- States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health
- States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services
Why are infectious diseases a global ethical issue?
• “Unrivalled consequences” • Control measures raise important questions re: violation of important rights – Right to freedom of movement – Right to privacy – Right to informed consent • Justice • Do not respect boundaries
Ethics of isolation and quarantine: Michael Selgelid lists 6 considerations
- Must be effective in controlling the disease
- If less restrictive measures achieve the same effect, use them
- Consequences of not quarantining must be severe
- Must be implemented in an equitable manner
- Must be minimally burdensome
- Those contained must receive compensation
Isolation = have disease Quarantine = exposed to disease, possibly have it
Research and clinical trials:
Name 3 good moral reasons for carrying out research in developing countries?
However, name 3 factors that will play a part?
- Global health inequalities
- Disproportionate burden of disease
- Value of research in developing countries
Factors:
• Less stringent ethical standards
• Cost
• Number of participants, particularly drug-naive
What was the key trial in the reviewing the control in clinical trials?
076 protocol (1994) of AZT and maternal-child transmission of HIV
Which is the correct control to use?
- Placebo vs experimental treatment
- Standard treatment vs experimental treatment
Participants were given placebo which violates declaration of Helsinki
What was the update to the declaration to Helsinki in 2013? (use of Placebo)
Flexibility:
“Where for compelling and scientifically sound methodological reasons the use of any intervention less effective than the best proven one, the use of placebo, or no intervention is necessary to determine the efficacy or safety of an intervention”
Important considerations in research and clinical trials
• Ethical review & protection of participants
• Healthcare infrastructure
– NB controversy over “controls” in clinical trials
• Valid consent
• Community engagement
• Benefits to participants after trial/ research is over
• The importance of collaborating with local scientists
What are the medical ethics in times of armed conflict?
Identical to medical ethics in times of peace, as stated in the International Code of Medical Ethics of the WMA
What inequalities and issues around justice were highlighted by the ebola outbreak?
– Ebola outbreak centred around some of the poorest countries in the world
• Lack of basic healthcare facilities to treat patients
• Lack of basic disease response infrastructure
– Originally not regarded as a Western problem (until cases
emerged in the US and Spain)
– Should Western healthcare workers working in affected countries be transferred to back to Western healthcare facilities?
– Who should receive the limited (experimental) treatments?
What were the research issues associated with drug administration during the ebola outbreak? (Justice: access to medication)
• Several promising drugs and treatments, which have not yet been evaluated for safety and efficacy in humans
• Panel was convened by the WHO in August 2014 to determine whether it was ethical to administer these despite the potential for unknown adverse effects and to determine who should receive priority
– Concluded ebola outbreak was exceptional and it was ethically acceptable to offer unproven interventions but ethical standards must be maintained
• Study design was also controversial (RCT ‘gold standard’ or not)
What 4 factors need to be considered when undertaking a medical elective in resource poor countries?
- Stay within your competence
- Maintain ethical standards
- Develop “cultural competence” (Bowman, 2011)
- Minimise burden on host country & healthcare system
